Effect of a Low-Fat or Low-Carbohydrate Weight-Loss Diet on Markers of Cardiovascular Risk Among Premenopausal Women: A Randomized Trial

Background: Low-fat and low-carbohydrate weight-loss diets can have a beneficial effect on longitudinal measures of blood pressure and blood lipids. We aimed to assess longitudinal changes in blood pressure and blood lipids in a population of premenopausal women. We hypothesized that results may differ by level of adherence to the respective diet protocol and baseline presence of hypertension or hyperlipidemia. Methods: Overweight or obese premenopausal women were randomized to a low-fat (n = 41) or low-carbohydrate (n = 38) diet. As part of the 52-week Lifestyle Eating and Fitness (LEAF) intervention trial, we fit linear mixed models to determine whether a change in outcome differed by treatment arm. Results: Within-group trends in blood pressure and blood lipids did not differ (p > 0.30). Across study arms, there was a significant decrease in systolic blood pressure (SBP, 3mm Hg, p = 0.01) over time, but diastolic blood pressure (DBP) did not change significantly over the course of the study. Blood lipids (total cholesterol [TC], low-density lipoproteins [LDL], and high-density lipoproteins [HDL]) all exhibited nonlinear trends over time (p < 0.01); each decreased initially but returned to levels comparable to baseline by study conclusion (p > 0.20). We observed a decline in SBP among women who were hypertensive at baseline (p < 0.01), but hypercholesterolemia at baseline did not affect trends in blood lipids (p > 0.40). Conclusions: Our results support that dietary interventions may be efficacious for lowering blood pressure and blood lipids among overweight or obese premenopausal women. However, a decrease in SBP was the only favorable change that was sustained in this study population. These changes can be maintained over the course of a 1-year intervention, yet changes in blood lipids may be less sustainable.